Assessment Form - Shanum Immigration Services Inc.

PERSONAL HISTORY

Full Name:

D.O.B:

Age:

Cell No:

Email:

Passport No:

Passport Expiry:

Address:

Marital Status:

Email:

Ages:

ACADEMIC RECORD

MASTERS:

Major:

Institute:

City:

Country:

From:

To:

Total number of years of degree:

BACHELORS:

Major:

Institute:

City:

Country:

From:

To:

Total number of years of degree:

Other DEGREE/DIPLOMA:

Major:

Institute:

City:

Country:

From:

To:

Additional information if any:

What is the equivalency report of your studies from WES/ ICAS/IQAS etc.

What is the date of equivalency report. Please provide the Report with this form

If not done yet, You must get the equivalency at your earliest.

WORK EXPERIENCE

EXPEREINCE 1:

Designation:

Company:

City:

Country:

From:

To:

Full Time / Part Time:

How many hours a week:

EXPEREINCE 2:

Designation:

Company:

City:

Country:

From:

To:

Full Time / Part Time:

How many hours a week:

EXPEREINCE 3:

Designation:

Company:

City:

Country:

From:

To:

Full Time / Part Time:

How many hours a week:

IELTS

Have you taken IELTS:

Academic or General:

Expiry of IELTS result:

Score: L: R: W: S:

If you do not have IELTS at this moment, you are not eligible to apply for Immigration to Canada.

SPOUSE INFORMATION

Full Name:

Age:

Highest degree:

Major:

From:

To:

No of Years Completed:

IELTS

Academic/General:

Validity Date:

Score: L: R: W: S:

SPOUSE WORK EXPERIENCE

EXPEREINCE 1:

Designation:

Company:

From:

To:

Full Time / Part Time:

How many hours a week:

EXPEREINCE 2:

Designation:

Company:

From:

To:

Full Time / Part Time:

How many hours a week:

Additional information if any:

ADDITIONAL INFORMATION

Relatives in Canada? Yes/No

Relationship:

Province:

Have you or your family been convicted of any crime: Yes/No

If yes, what is the nature of conviction:

Have you applied a visa to Canada or any country in the past: Yes/NO:

Any visa Refusal to Canada or any other country ?(year of refusal):

Valid Visas to Countries:

Deported or removed from any Country:

Claimed a refugee status in any country including Canada in the Past? YES/NO:

If Yes, Which country?

When:

Date of deportation or removal from any country including Canada: YES/NO

Have you had Citizenship of any other country:

Funds Available? How much?

DECLARATION

I hereby declare that the above information is correct to the best of my knowledge and belief. I shall be held responsible for any consequences if assessment is influenced

Signature

Date: (mm/dd/yyyy)